LARA MARIE WIZIECKI DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****73

License Status

ACTIVE

Business

First Name

LARA

Middle

MARIE

Last Name

WIZIECKI

Suffix

Business Name

LARA MARIE WIZIECKI DO

Original Issue Date

06/24/1999

Effective Date

04/11/2023

Expiration Date

07/31/2026

City

ORLAND PARK

State

Zip

60462

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2023